Normal Speech, but Upper Range Loss

VOICE INDEX

• Introduction / The Voice Team

• Photo Library

• Normal Voice

• Raspy Voice

• Normal Speech, but Upper Range Loss

• Breathy or Lost Voice

• Voice That Catches/Spasms (Spasmodic Dysphonia)

• "Noisy Breathing"

• Nasal Sounding Speech

• Laryngitis

• Miscellaneous

• Treatment?

Other Topics

• Fiberoptic Endoscopy

• Vocal Cord Dysfunction

• Muscle Tension Dysphonia

• Chronic Cough

• Lump in the Throat (Globus Pharyngeus)

• Ear Fullness or Popping / Crackling

• Allergy Info

• Hearing Loss

• Sinusitis

• Zenker's Diverticulum

• Snoring and OSA

• Acid Reflux (LPR)

• Halitosis (Bad Breath)

• Epistaxis (Nosebleeds)

• Migraine Headaches

• TMJ

• More Topics!

Videos On ENT Topics

The Voice with Normal Speech, but Loss of Upper Range Quality
by Christopher Chang, MD • Last Modified 1/29/2007

This section will go over a variety of lesions that leads to a raspy voice in the higher pitches of voice. However, speech is usually normal although a person may describe the voice as being intermittently raspy as well (see Raspy Voice and Laryngitis section). This particular scenario is what singer's fear and is the most common presenting complaint to an ENT office. In order to evaluate these patients, the entire vocal range needs to be investigated. The best way is to have the patient sing the first line of a universally known song, "Happy Birthday" very softly at different pitch ranges and listen for pitch breaks, onset delays, and diplophonia. Treatment depends on the cause and may include surgery and/or voice therapy.

Small Polyp • Large Polyp • Saccular & Ventricular Cyst • Vocal Cord Nodules #1 • Vocal Cord Nodules #2 • Vocal Cord Cyst
Vocal Cord Swelling • Diplophonia • Pitch Breaks

NOTE: Please allow sufficient time for the audio and movie files to upload. All files are around 1-2 megabytes in size. If you are unable to see the movies, then you may not have the QuickTime plugin. You will need to download and install ActiveX and QuickTime to view these video and audio clips. The plugin is available for free download at Apple. QuickTime and the QuickTime Logo are trademarks of Apple Computer, Inc., registered in the U.S. and other countries.

Click here for audio & video of what normal looks like.
Photos displaying abnormalities can be found in the Photo Library.

Example 1: Small Polyp Audio - Standard Passage Audio - "Happy Birthday" Click here to view video. Note that the voice breaks in the upper range of singing Happy Birthday which indicates a mass on the vocal cords. In the video, this suspicion is confirmed by a small polyp developing on the free edge of the left true vocal cord with reactive swelling on the right true vocal cord. Back to Top	Click here to view video. You must have QuickTime plugin installed to view video.
Example 2: Large Polyp Audio - Standard Passage Audio - "Happy Birthday" Click here to view video. As in example 1, note that the voice breaks in the upper range of singing Happy Birthday as well as moments of diplophonia which indicates a mass on the vocal cords. On the video, there is large polyp on the left vocal cord. Example provided courtesy of Dr. James Thomas. Back to Top	Click here to view video. You must have QuickTime plugin installed to view video.
Example 3: Saccular and Ventricular Cyst Audio - Standard Passage Audio - "Happy Birthday" Click here to view video. Note the normal speech but voice breaks in the upper range. On the video, there is a cyst bulging near the front and on top of the right vocal cord (saccular cyst). There is also another cyst on top of the mid-left vocal cord (ventricular cyst). In the upper range, the cyst touches down and interferes with the vocal cord vibration resulting in pitch breaks and onset delays. Example provided courtesy of Dr. James Thomas. Back to Top	Click here to view video. You must have QuickTime plugin installed to view video.
Example 4: Vocal Cord Nodules Audio - Standard Passage Audio - "Happy Birthday" Click here to view video. Note the normal speech but voice breaks in the upper range. On the video, there are nodules bilaterally along the mid-vocal cords. However, the left nodule is bigger than the right. Back to Top	Click here to view video. You must have QuickTime plugin installed to view video.
Example 4 Cont'd: Vocal Cord Nodules #2 Audio - Standard Passage Audio - "Happy Birthday" Click here to view video. Yet another example of vocal cord nodules with a slightly different apearance in a different patient. Onset delays are quite prominent at the higher pitches. The video was obtained with a rigid 70° endoscope. Back to Top	Click here to view video. You must have QuickTime plugin installed to view video.
Example 5: Vocal Cord Cyst Audio - Standard Passage Audio - "Happy Birthday" Click here to view video. Note the normal speech but voice breaks in the upper range. On the video, the cyst is located in the mid-right vocal cord free edge. Back to Top	Click here to view video. You must have QuickTime plugin installed to view video.
Example 6: Vocal Cord Swelling Audio - Standard Passage Audio - "Happy Birthday" Click here to view video. Vocal cord swelling is perhaps the most common cause of upper range hoarseness in singers and in people who generally like to talk a lot. It is considered the very first stage before further injury leading to nodule/cyst/polyp formation. If you listen to the happy birthday song, one can hear onset delays and pitch breaks most notably in the upper ranges suggesting a mass/swelling on the vocal cord. The picture displayed shows the classic hourglass gap indicative of this swelling. No obvious mass (ie, nodule/cyst/polyp) is apparent. The video will show the swelling and how it affects the upper ranges with a very clear pitch break towards the end. Vocal cord swelling is treatable with speech therapy; in singers, preferably by a trained voice pedagogue familiar with vocal cord swelling. Overall strategies to address vocal cord swelling are outlined here. Back to Top	Click here to view video. You must have QuickTime plugin installed to view video.
Example 7: Diplophonia Due to Vocal Cord Masses Click here to view video #1. Click here to view video #2. As you may also have realized, if one hears diplophonia (two different tones simultaneously), that finding alone does indicate a vocal cord mass. The two tones occur as the vocal cords behind the mass vibrate at a different frequency than the vocal cords in front of the mass. In essence, it creates a situation where there are 4 vocal cords instead of 2. Examples provided courtesy of Dr. James Thomas. Back to Top	Click here to view video. You must have QuickTime plugin installed to view video. Click here to view video. You must have QuickTime plugin installed to view video.
Example 8: Specific Frequency Pitch Breaks Click here to view video. Another suggestion that there might be a vocal cord mass is a pitch break at a specific frequency. Note that the voice sounds good except at certain pitches where the voice breaks. Example provided courtesy of Dr. James Thomas. Back to Top	Click here to view video. You must have QuickTime plugin installed to view video.

Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment.